| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
11,616 |
2,885 |
$593K |
| D1110 |
Prophylaxis - adult |
8,648 |
8,639 |
$392K |
| D5110 |
|
603 |
601 |
$290K |
| D0210 |
Intraoral - complete series of radiographic images |
4,023 |
4,004 |
$251K |
| D1120 |
Prophylaxis - child |
5,833 |
5,827 |
$226K |
| D5120 |
|
412 |
412 |
$192K |
| D1206 |
Topical application of fluoride varnish |
6,746 |
6,739 |
$162K |
| D0274 |
Bitewings - four radiographic images |
3,629 |
3,627 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,432 |
4,427 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
2,252 |
2,227 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,814 |
4,724 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,679 |
1,675 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,847 |
1,842 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
671 |
434 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
636 |
459 |
$43K |
| D4355 |
|
419 |
417 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
200 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,853 |
1,834 |
$20K |
| D7310 |
|
131 |
52 |
$16K |
| D2140 |
|
269 |
213 |
$13K |
| D5710 |
|
14 |
14 |
$3K |
| D2160 |
|
15 |
13 |
$1K |
| D2330 |
|
18 |
12 |
$1K |
| D0191 |
|
27 |
27 |
$405.00 |
| D9986 |
|
14 |
14 |
$0.00 |